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Hitomi S, Ujihara I, Sago-Ito M, Nodai T, Shikayama T, Inenaga K, Ono K. Hyposalivation due to chemotherapy exacerbates oral ulcerative mucositis and delays its healing. Arch Oral Biol 2019; 105:20-26. [PMID: 31238198 DOI: 10.1016/j.archoralbio.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 05/18/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Cancer therapy including chemotherapy causes gland atrophy, resulting in low salivary secretion in cancer patients. Since saliva plays an important role in oral health, the dysfunction may exacerbate oral ulcerative mucositis (OUM), which is another side effect. Here, we investigated the effect of hyposalivation on OUM using sialoadenectomized rats and examined the effects of anticancer drugs on the salivary glands. DESIGN As models for hyposalivation, the bilateral submandibular and sublingual glands except (2EXT) or together with (3EXT) the parotid glands were extracted. At 16 days after the procedure, OUM was experimentally developed by topical acetic acid treatment on the labial fornix region of the inferior incisors, and the severity and bacterial loading level were evaluated. The salivary gland weights and histology were analyzed after administration of the representative anticancer drugs 5-fluorouracil or cisplatin. RESULTS The severity of OUM was greater in both the 3EXT and 2EXT rats and delayed the healing process compared with that in sham rats without salivary gland extraction. The healing process in the 3EXT rats was longer than that in the 2EXT rats. The number of colony-forming units in the ulcerative region from the 3EXT rats was 10-fold greater than that in the sham rats. Both 5-fluorouracil and cisplatin reduced glands weights and damaged the salivary glands. CONCLUSIONS These results suggest that chemotherapy-induced hyposalivation exacerbates OUM and delays healing, most likely due to loss of salivary clearance and antimicrobial functions. This study illustrates the significance of oral health care for cancer patients undergoing chemotherapy.
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Affiliation(s)
- Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan.
| | - Izumi Ujihara
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Misa Sago-Ito
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Orofacial Functions and Orthodontics, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Tomotaka Nodai
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Takemi Shikayama
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Periodontology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kiyotoshi Inenaga
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
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Lulloff AJ, Vessey JA, Bashore L, Gregas M. Nutrition-Related Clinical Decision Making of Pediatric Oncology Nurses. J Pediatr Oncol Nurs 2019; 36:352-360. [PMID: 31027451 DOI: 10.1177/1043454219844233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Children with a cancer diagnosis have risk factors leading to unique nutritional challenges. Malnutrition in this population is correlated with worse patient outcomes. Nurses are responsible for providing holistic care to their patients; however, the quality of nutritional assessments by pediatric oncology nurses is unknown. The purpose of this study was to investigate staff nurses' clinical decision making regarding nutritional assessment of children with cancer. A web-based survey composed of a demographic form, vignettes of patients with diverse nutritional status and the New General Self-Efficacy Scale, was distributed to members of the Association of Pediatric Hematology Oncology Nurses. Participants were also asked to rate their confidence in responses as well as select key nutritional cues. Nurses were significantly more likely to under-rate the nutritional status and select far fewer cues than the experts. Further research regarding nutritional assessment is warranted. Evidenced-based guidelines for nutritional assessment of children with cancer should be developed to ensure the highest quality of care is provided to this patient population.
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Affiliation(s)
| | - Judith A Vessey
- 2 Boston College, Chestnut Hill, MA, USA.,3 Boston Children's Hospital, Chestnut Hill, MA, USA
| | - Lisa Bashore
- 4 Texas Christian University, Fort Worth, TX, USA.,5 Cook Children's Health Care System, Fort Worth, TX, USA
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Goto H, Kiyohara Y, Shindo M, Yamamoto O. Symptoms of and Palliative Treatment for Unresectable Skin Cancer. Curr Treat Options Oncol 2019; 20:34. [DOI: 10.1007/s11864-019-0626-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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54
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Gillis C, Wischmeyer PE. Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia 2019; 74 Suppl 1:27-35. [PMID: 30604414 DOI: 10.1111/anae.14506] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2018] [Indexed: 01/04/2023]
Abstract
Pre-operative nutrition therapy is increasingly recognised as an essential component of surgical care. The present review has been formatted using Simon Sinek's Golden Circle approach to explain 'why' avoiding pre-operative malnutrition and supporting protein anabolism are important goals for the elective surgical patient, 'how' peri-operative malnutrition develops leading in part to a requirement for pre-operative anabolic preparation, and 'what' can be done to avoid pre-operative malnutrition and support anabolism for optimal recovery.
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Affiliation(s)
- C Gillis
- Peri-Operative Program, McGill University, Montreal, QC, Canada
| | - P E Wischmeyer
- Director of Peri-operative Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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55
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Kim E, Kang JS, Han Y, Kim H, Kwon W, Kim JR, Kim SW, Jang JY. Influence of preoperative nutritional status on clinical outcomes after pancreatoduodenectomy. HPB (Oxford) 2018; 20:1051-1061. [PMID: 29887259 DOI: 10.1016/j.hpb.2018.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/24/2018] [Accepted: 05/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the clinical outcomes according to the preoperative nutritional status and to identify factors influencing long-term unrecovered nutritional status. METHODS Data were prospectively collected from 355 patients who underwent PD between 2008 and 2014. Nutritional status was evaluated by Mini Nutrition Assessment (MNA) and patients were classified into group A (malnourished), group B (risk-of-malnutrition), or group C (well-nourished). MNA score, complications, body mass index (BMI), stool elastase level, biochemical parameters, and quality-of-life (QOL) were collected serially for 1 year. RESULTS Preoperatively, 60 patients were categorized into group A, 224 into group B, and 71 into group C. Overall complication and pancreatic fistula were higher in groups A and B compared with group C (P = 0.003 vs P = 0.004). QOL, biochemical parameters, BMI and stool elastase level were lowest in group A preoperatively. BMI and stool elastase level remained low after surgery in all groups. Advanced age, low BMI, pre-existing diabetes mellitus, jaundice, exocrine insufficiency and adjuvant therapy were factors influencing long-term unrecovered nutritional status. CONCLUSION Preoperative malnourished patients suffer from poor clinical outcomes. Therefore, those with risk factors of malnutrition should be monitored and vigorous efforts are needed to improve their nutrition.
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Affiliation(s)
- Eunjung Kim
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea; Department of Nursing, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jae Seung Kang
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Youngmin Han
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hongbeom Kim
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Wooil Kwon
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Ri Kim
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun-Whe Kim
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Young Jang
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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Purcell SA, Xiao J, Ford KL, Prado CM. The Role of Energy Balance on Colorectal Cancer Survival. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0423-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ge W, Xie J, Chang L. Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma. Cancer Manag Res 2018; 10:3611-3618. [PMID: 30271209 PMCID: PMC6152606 DOI: 10.2147/cmar.s176200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Although red blood cell distribution width (RDW) has been reported to reflect inflammation and nutritional status and to predict prognosis in several different types of cancer, little is known about how RDW might be related to oral squamous cell carcinoma (OSCC). The present study aimed to investigate the prognostic value of preoperative RDW in OSCC patients. Materials and methods We included 236 OSCC patients from Jinan Stomatological Hospital (Shandong, People’s Republic of China) in this retrospective study. All enrolled patients were divided into 2 groups: high RDW (≥15%) and low RDW (<15%) according to the detected RDW values. The correlation of RDW and clinical characteristics was explored, and the prognostic significance of RDW evaluated using Kaplan–Meier curves, log-rank analysis, and the Cox proportional hazards model. Results The pretreatment median RDW among all OSCC patients was 14.4%, with a range from 11.6% to 24.5%. The RDW was found to be significantly correlated with node metastasis, tumor length, and TNM stage (P<0.05 for all). As for biochemical parameters, the results showed that higher RDW values were significantly associated with hemoglobin, mean corpuscular volume, white blood cell count, albumin, and C-reactive protein (P<0.01 for all). A significant association of RDW with the tumor marker cytokeratin 19 fragments (CYFRA21-1) and squamous cell carcinoma antigen (SCC-Ag) was also observed (P=0.02, and P=0.03; respectively). Moreover, patients with higher RDW were more likely to receive postoperative therapy (P=0.02). Kaplan–Meier survival curves showed that a high RDW was significantly associated with poor overall survival (OS) (P<0.01), especially in the early stages (I–II). Multivariate analysis revealed that an elevated RDW at diagnosis was an independent prognostic factor for shorter OS (HR =1.46, 95% CI: 1.13–2.86) after adjustment for other cancer-related prognostic factors. Conclusion These data suggest that an elevated preoperative RDW (≥15%) at diagnosis may independently predict poorer OS in patients with OSCC, but better-designed studies in the future should be performed to further confirm the value of monitoring RDW.
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Affiliation(s)
- Wenzhang Ge
- Department of Special Clinic, Jinan Stomatological Hospital, Jinan, Shandong, People's Republic of China
| | - Jianli Xie
- Department of Periodontics and Oral Medicine, Jinan Stomatological Hospital, Jinan, Shandong, People's Republic of China
| | - Lianzhen Chang
- Medical Department, Jinan Stomatological Hospital, Jinan, Shandong, People's Republic of China,
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Cancer cachexia: Diagnosis, assessment, and treatment. Crit Rev Oncol Hematol 2018; 127:91-104. [PMID: 29891116 DOI: 10.1016/j.critrevonc.2018.05.006] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsiveness to chemotherapy, and survival in advanced cancer patients. Our understanding of cachexia has grown greatly in recent years and the roles of many tumor-derived and host-derived compounds have been elucidated as mediators of cancer cachexia. However, cancer cachexia remains an unmet medical need and attempts towards a standard treatment guideline have been unsuccessful. This review covers the diagnosis, assessment, and treatment of cancer cachexia; the elements impeding the formulation of a standard management guideline; and future directions of research for the improvement and standardization of current treatment procedures.
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Guo D, Wang C, Wang Q, Qiao Z, Tang H. Pantoprazole blocks the JAK2/STAT3 pathway to alleviate skeletal muscle wasting in cancer cachexia by inhibiting inflammatory response. Oncotarget 2018; 8:39640-39648. [PMID: 28489606 PMCID: PMC5503639 DOI: 10.18632/oncotarget.17387] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/27/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Cancer cachexia is often present in patients with advanced malignant tumors, and the subsequent body weight reduction results in poor quality of life. However, there has been no progress in developing effective clinical therapeutic strategies for skeletal muscle wasting in cancer cachexia. Herein, we explored the functions of pantoprazole on cancer cachexia skeletal muscle wasting. METHODS The mouse colon adenocarcinoma cell line C26 was inoculated in the right forelimb of male BALB/C mice to establish a cancer cachexia model. The animals were treated with or without different concentrations of pantoprazole orally, and the body weight, tumor growth, spontaneous activity, and muscle functions were determined at various time points. Two weeks later, the levels of serum IL-6 and TNF-α, the mRNA levels of gastrocnemius JAK2 and STAT3, and the expression levels of p-JAK2, p-STAT3, Fbx32, and MuRF1 were examined with ELISA assay, qRT-PCR assay, and Western blotting, respectively. Further studies were performed to assess the levels of Fbx32 and MuRF1 expression and morphological changes. RESULTS Pantoprazole can alleviate cancer cachexia-induced body weight reduction and inhibit skeletal muscle wasting in a dose-dependent manner. Our results indicated that pantoprazole treatment can decrease the levels of serum IL-6 and TNF-α (56.3% and 67.6%, respectively), and inhibit the activation of the JAK2/STAT3 signaling pathway. Moreover, the expression levels of MuRF1 and Fbx32 were also suppressed after pantoprazole treatment. CONCLUSION Our findings suggested that pantoprazole can alleviate cancer cachexia skeletal muscle wasting by inhibiting the inflammatory response and blocking the JAK2/STAT3 or ubiquitin proteasome pathway.
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Affiliation(s)
- Dunwei Guo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University Chongqing 400016, China
| | - Chaoyi Wang
- Department of Breast Surgery, Chongqing Three Gorges Central Hospital, Chongqing 404000, China
| | - Qiang Wang
- Department of Gastrointestinal Surgery, Suining Municipal Central Hospital, Suining, Sichuan 629000, China
| | - Zhongpeng Qiao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University Chongqing 400016, China
| | - Hua Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University Chongqing 400016, China
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Ferioli M, Zauli G, Martelli AM, Vitale M, McCubrey JA, Ultimo S, Capitani S, Neri LM. Impact of physical exercise in cancer survivors during and after antineoplastic treatments. Oncotarget 2018; 9:14005-14034. [PMID: 29568412 PMCID: PMC5862633 DOI: 10.18632/oncotarget.24456] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/23/2018] [Indexed: 12/12/2022] Open
Abstract
Cancer patients experience symptoms and adverse effects of treatments that may last even after the end of treatments. Exercise is a safe, non-pharmacological and cost-effective therapy that can provide several health benefits in cancer patient and survivors, reducing cancer symptoms and cancer treatment side effects. The purpose of this review is to describe how the physical exercise is capable to reduce cancer symptoms and cancer treatment side effects. We realized a pragmatic classification of symptoms, dividing them into physical, psychological and psycho-physical aspects. For each symptom we discuss causes, therapies, we analyse the effects of physical exercise and we summarize the most effective type of exercise to reduce the symptoms. This review also points out what are the difficulties that patients and survivors face during the practice of physical activity and provides some solutions to overcome these barriers. Related to each specific cancer, it emerges that type, frequency and intensity of physical exercise could be prescribed and supervised as a therapeutic program, like it occurs for the type, dose and duration of a drug treatment.
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Affiliation(s)
- Martina Ferioli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Zauli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alberto M Martelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Vitale
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- CoreLab, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Simona Ultimo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Silvano Capitani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Luca M Neri
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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61
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The relationship between nutritional status and handgrip strength in adult cancer patients: a cross-sectional study. Support Care Cancer 2018; 26:2441-2451. [DOI: 10.1007/s00520-018-4082-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022]
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62
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Zhang Z, Zhu Y, Zhang L, Wang Z, Wan H. Prediction model of critical weight loss in cancer patients during particle therapy. Jpn J Clin Oncol 2018; 48:75-81. [PMID: 29045700 DOI: 10.1093/jjco/hyx145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/23/2017] [Indexed: 11/12/2022] Open
Abstract
Background and purpose The objective of this study is to investigate the predictors of critical weight loss in cancer patients receiving particle therapy, and build a prediction model based on its predictive factors. Materials and methods Patients receiving particle therapy were enroled between June 2015 and June 2016. Body weight was measured at the start and end of particle therapy. Association between critical weight loss (defined as >5%) during particle therapy and patients' demographic, clinical characteristic, pre-therapeutic nutrition risk screening (NRS 2002) and BMI were evaluated by logistic regression and decision tree analysis. Results Finally, 375 cancer patients receiving particle therapy were included. Mean weight loss was 0.55 kg, and 11.5% of patients experienced critical weight loss during particle therapy. The main predictors of critical weight loss during particle therapy were head and neck tumour location, total radiation dose ≥70 Gy on the primary tumour, and without post-surgery, as indicated by both logistic regression and decision tree analysis. Prediction model that includes tumour locations, total radiation dose and post-surgery had a good predictive ability, with the area under receiver operating characteristic curve 0.79 (95% CI: 0.71-0.88) and 0.78 (95% CI: 0.69-0.86) for decision tree and logistic regression model, respectively. Conclusions Cancer patients with head and neck tumour location, total radiation dose ≥70 Gy and without post-surgery were at higher risk of critical weight loss during particle therapy, and early intensive nutrition counselling or intervention should be target at this population.
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Affiliation(s)
- Zhihong Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center
| | - Yu Zhu
- Department of Nursing, Shanghai Proton and Heavy Ion Center
| | - Lijuan Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center
| | - Ziying Wang
- Department of Head and Neck Cancer, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Hongwei Wan
- Department of Nursing, Shanghai Proton and Heavy Ion Center
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Barreto R, Waning DL, Gao H, Liu Y, Zimmers TA, Bonetto A. Chemotherapy-related cachexia is associated with mitochondrial depletion and the activation of ERK1/2 and p38 MAPKs. Oncotarget 2017; 7:43442-43460. [PMID: 27259276 PMCID: PMC5190036 DOI: 10.18632/oncotarget.9779] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/16/2016] [Indexed: 12/21/2022] Open
Abstract
Cachexia affects the majority of cancer patients, with currently no effective treatments. Cachexia is defined by increased fatigue and loss of muscle function resulting from muscle and fat depletion. Previous studies suggest that chemotherapy may contribute to cachexia, although the causes responsible for this association are not clear. The purpose of this study was to investigate the mechanism(s) associated with chemotherapy-related effects on body composition and muscle function. Normal mice were administered chemotherapy regimens used for the treatment of colorectal cancer, such as Folfox (5-FU, leucovorin, oxaliplatin) or Folfiri (5-FU, leucovorin, irinotecan) for 5 weeks. The animals that received chemotherapy exhibited concurrent loss of muscle mass and muscle weakness. Consistently with previous findings, muscle wasting was associated with up-regulation of ERK1/2 and p38 MAPKs. No changes in ubiquitin-dependent proteolysis or in the expression of TGFβ-family members were detected. Further, marked decreases in mitochondrial content, associated with abnormalities at the sarcomeric level and with increase in the number of glycolytic fibers were observed in the muscle of mice receiving chemotherapy. Finally, ACVR2B/Fc or PD98059 prevented Folfiri-associated ERK1/2 activation and myofiber atrophy in C2C12 cultures. Our findings demonstrate that chemotherapy promotes MAPK-dependent muscle atrophy as well as mitochondrial depletion and alterations of the sarcomeric units. Therefore, these findings suggest that chemotherapy potentially plays a causative role in the occurrence of muscle loss and weakness. Moreover, the present observations provide a strong rationale for testing ACVR2B/Fc or MEK1 inhibitors in combination with anticancer drugs as novel strategies aimed at preventing chemotherapy-associated muscle atrophy.
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Affiliation(s)
- Rafael Barreto
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - David L Waning
- Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,IUPUI Center for Cachexia Research, Innovation and Therapy, Indianapolis, IN 46202, USA
| | - Hongyu Gao
- Department of Medical and Molecular Genetics, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Teresa A Zimmers
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,IUPUI Center for Cachexia Research, Innovation and Therapy, Indianapolis, IN 46202, USA
| | - Andrea Bonetto
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,IUPUI Center for Cachexia Research, Innovation and Therapy, Indianapolis, IN 46202, USA
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Gangadharan A, Choi SE, Hassan A, Ayoub NM, Durante G, Balwani S, Kim YH, Pecora A, Goy A, Suh KS. Protein calorie malnutrition, nutritional intervention and personalized cancer care. Oncotarget 2017; 8:24009-24030. [PMID: 28177923 PMCID: PMC5410360 DOI: 10.18632/oncotarget.15103] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/23/2017] [Indexed: 12/27/2022] Open
Abstract
Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of <50% of recommended intake for 2 weeks or more; bedridden or otherwise significantly reduced functional capacity; weight loss of >2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of the effort to alleviate effects of malnutrition on quality of life and survival of patients.
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Affiliation(s)
- Anju Gangadharan
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Sung Eun Choi
- Department of Family, Nutrition, and Exercise Sciences, Queens College, The City University of New York, Flushing, NY, USA
| | - Ahmed Hassan
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Nehad M Ayoub
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Gina Durante
- Department of Clinical Nutrition, Baystate Medical Center, Springfield, MA, USA
| | - Sakshi Balwani
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Young Hee Kim
- Department of Clinical Nutrition, Baystate Medical Center, Springfield, MA, USA
| | - Andrew Pecora
- Clinical Divisions, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Andre Goy
- Clinical Divisions, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - K Stephen Suh
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
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Abstract
PURPOSE OF REVIEW Cancer anorexia is a negative prognostic factor and is broadly defined as the loss of the interest in food. However, multiple clinical domains contribute to the phenotype of cancer anorexia. The characterization of the clinical and molecular pathophysiology of cancer anorexia may enhance the efficacy of preventive and therapeutic strategies. RECENT FINDINGS Clinical trials showed that cancer anorexia should be considered as an umbrella encompassing different signs and symptoms contributing to appetite disruption in cancer patients. Loss of appetite, early satiety, changes in taste and smell are determinants of cancer anorexia, whose presence should be assessed in cancer patients. Interestingly, neuronal correlates of cancer anorexia-related symptoms have been revealed by brain imaging techniques. SUMMARY The pathophysiology of cancer anorexia is complex and involves different domains influencing eating behavior. Limiting the assessment of cancer anorexia to questions investigating changes in appetite may impede correct identification of the targets to address.
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Affiliation(s)
- Alessandro Laviano
- aDepartment of Clinical Medicine bDepartment of Clinical and Molecular Medicine, Sapienza University, Rome, Italy cCancer Metabolism Research Group, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Abstract
Oncology patients often experience the classic signs of malnutrition-weight loss as well as fat and muscle wasting, which have been associated with poor tolerance to treatment and increased morbidity and mortality. Nutrition status may be an important factor in determining tolerance to treatment and outcomes associated with it. Thus, identification of those with preexisting malnutrition or who are at risk for developing malnutrition is crucial not only at time of cancer diagnosis but also throughout the treatment course so that nutrition interventions may be implemented to prevent development or worsening of malnutrition in this high-risk population. These patients often have extremely complicated hospital courses due to the aggressive nature of the disease and treatment, leading to intensive care unit admission and periods of critical illness. Critical illness is associated with catabolism, extreme stress on the body, and a state of systemic inflammation. During critical illness, it is important to provide adequate nutrition to prevent further break down of lean muscle mass and oxidative cellular injury and to regulate favorable immune responses. The purpose of this review is to discuss the importance of nutrition screening and assessment for the critically ill patient with cancer; to appropriately identify those at risk for, or who have developed, malnutrition; and to provide appropriate interventions to optimize nutrition status. This review also discusses the complications and difficulties associated with feeding this patient population and offers nutrition support recommendations.
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Affiliation(s)
- Kristen Lach
- 1 Rush University Medical Center, Chicago, Illinois, USA
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Spotten L, Corish C, Lorton C, Ui Dhuibhir P, O’Donoghue N, O’Connor B, Walsh T. Subjective and objective taste and smell changes in cancer. Ann Oncol 2017; 28:969-984. [DOI: 10.1093/annonc/mdx018] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Brown TE, Wittholz K, Way M, Banks MD, Hughes BGM, Lin CY, Kenny LM, Bauer JD. Investigation of p16 status, chemotherapy regimen, and other nutrition markers for predicting gastrostomy in patients with head and neck cancer. Head Neck 2017; 39:868-875. [DOI: 10.1002/hed.24630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/05/2016] [Accepted: 10/07/2016] [Indexed: 12/23/2022] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Queensland Australia
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| | - Kym Wittholz
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| | - Mandy Way
- QIMR; Berghofer Medical Research Institute; Herston Queensland Australia
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Queensland Australia
| | - Charles Y. Lin
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth M. Kenny
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Judith D. Bauer
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
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69
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Wei TT, Tang QQ, Qin BD, Ma N, Wang LL, Zhou L, Zhong RQ. Elevated red blood cell distribution width is associated with liver function tests in patients with primary hepatocellular carcinoma. Clin Hemorheol Microcirc 2017; 64:149-155. [PMID: 27002894 DOI: 10.3233/ch-162053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Red blood cell distribution width (RDW), a routinely tested parameter of the complete blood count (CBC), has been reported to be increased in various cancers and correlated with the patients' clinical characteristics. However, the significance of RDW in primary hepatocellular carcinoma (pHCC) is largely unknown. The aim of this study was to evaluate the associations between RDW and the clinical characteristics of pHCC patients. METHODS Medical records of 110 treatment-naive pHCC patients were retrospectively reviewed. Their clinical characteristics on admission, including RDW, liver function tests and tumor stage, were extracted, and their relationships were analyzed using Spearman correlation and Kruskal-Wallis test. Sixty-eight healthy individuals were set as controls. RESULTS RDW was significantly increased in pHCC patients and correlated with the liver function tests. However, no correlation between RDW and tumor stage was found. CONCLUSION RDW may be used to assess the liver function, but not the tumor stage in pHCC patients.
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70
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Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Surgical Prehabilitation in Patients with Cancer. Phys Med Rehabil Clin N Am 2017; 28:49-64. [DOI: 10.1016/j.pmr.2016.09.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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71
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Distinct TRPV1- and TRPA1-based mechanisms underlying enhancement of oral ulcerative mucositis-induced pain by 5-fluorouracil. Pain 2017; 157:1004-1020. [PMID: 26808144 DOI: 10.1097/j.pain.0000000000000498] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In many patients with cancer, chemotherapy-induced severe oral ulcerative mucositis causes intractable pain, leading to delays and interruptions in therapy. However, the pain mechanism in oral ulcerative mucositis after chemotherapy has not been extensively studied. In this study, we investigated spontaneous pain and mechanical allodynia in a preclinical model of oral ulcerative mucositis after systemic administration of the chemotherapy drug 5-fluorouracil, using our proprietary pain assay system for conscious rats. 5-Fluorouracil caused leukopenia but did not induce pain-related behaviors. After 5-fluorouracil administration, oral ulcers were developed with topical acetic acid treatment. Compared with saline-treated rats, 5-fluorouracil-exposed rats showed more severe mucositis with excessive bacterial loading due to a lack of leukocyte infiltration, as well as enhancements of spontaneous pain and mechanical allodynia. Antibacterial drugs, the lipid A inhibitor polymyxin B and the TRPV1/TRPA1 channel pore-passing anesthetic QX-314, suppressed both the spontaneous pain and the mechanical allodynia. The cyclooxygenase inhibitor indomethacin and the TRPV1 antagonist SB-366791 inhibited the spontaneous pain, but not the mechanical allodynia. In contrast, the TRPA1 antagonist HC-030031 and the N-formylmethionine receptor FPR1 antagonist Boc MLF primarily suppressed the mechanical allodynia. These results suggest that 5-fluorouracil-associated leukopenia allows excessive oral bacterial infection in the oral ulcerative region, resulting in the enhancement of spontaneous pain through continuous TRPV1 activation and cyclooxygenase pathway, and mechanical allodynia through mechanical sensitization of TRPA1 caused by neuronal effects of bacterial toxins. These distinct pain mechanisms explain the difficulties encountered with general treatments for oral ulcerative mucositis-induced pain in patients with cancer and suggest more effective approaches.
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Peterson SJ, Mozer M. Differentiating Sarcopenia and Cachexia Among Patients With Cancer. Nutr Clin Pract 2016; 32:30-39. [PMID: 28124947 DOI: 10.1177/0884533616680354] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients with cancer are at an increased risk for muscle loss via 2 distinct mechanisms: sarcopenia, defined as the age-associated decrease in muscle mass related to changes in muscle synthesis signaling pathways, and/or cachexia, defined as cytokine-mediated degradation of muscle and adipose depots. Both wasting disorders are prevalent; among patients with cancer, 15%-50% are sarcopenic and 25%-80% are cachectic. Muscle mass may be difficult to quantify in overweight/obese individuals. Often, overweight/obese patients with cancer are assumed to be normally nourished when in fact severe muscle depletion may be present. No universally accepted treatment exists for preventing or reversing sarcopenia or cachexia in patients with cancer. Current treatment options are limited to nutrition therapy and exercise, which may lead to difficulties in adherence during cancer treatment. Future treatments may provide pharmaceutical therapy that targets muscle degradation and synthesis pathways. There is a need to determine a multimodal treatment plan for muscle depletion to improve quality of life, survival, and therapy complications in patients with cancer.
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Affiliation(s)
- Sarah J Peterson
- 1 Department of Clinical Nutrition/Department of Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Marisa Mozer
- 1 Department of Clinical Nutrition/Department of Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
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Musolino V, Palus S, Tschirner A, Drescher C, Gliozzi M, Carresi C, Vitale C, Muscoli C, Doehner W, von Haehling S, Anker SD, Mollace V, Springer J. Megestrol acetate improves cardiac function in a model of cancer cachexia-induced cardiomyopathy by autophagic modulation. J Cachexia Sarcopenia Muscle 2016; 7:555-566. [PMID: 27239419 PMCID: PMC4864048 DOI: 10.1002/jcsm.12116] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/24/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cachexia is a complex metabolic syndrome associated with cancer. One of the features of cachexia is the loss of muscle mass, characterized by an imbalance between protein synthesis and protein degradation. Muscle atrophy is caused by the hyperactivation of some of the main cellular catabolic pathways, including autophagy. Cachexia also affects the cardiac muscle. As a consequence of the atrophy of the heart, cardiac function is impaired and mortality is increased. Anti-cachectic therapy in patients with cancer cachexia is so far limited to nutritional support and anabolic steroids. The use of the appetite stimulant megestrol acetate (MA) has been discussed as a treatment for cachexia. METHODS In this study the effects of MA were tested in cachectic tumour-bearing rats (Yoshida AH-130 ascites hepatoma). Rats were treated daily with 100 mg/kg of MA or placebo starting one day after tumour inoculation, and for a period of 16 days. Body weight and body composition were assessed at baseline and at the end of the study. Cardiac function was analysed by echocardiography at baseline and at day 11. Locomotor activity and food intake were assessed before tumour inoculation and at day 11. Autophagic markers were assessed in gastrocnemius muscle and heart by western blot analysis. RESULTS Treatment with 100 mg/kg/day MA significantly attenuated the loss of body weight (-9 ± 12%, P < 0.05) and the wasting of lean and fat mass (-7.0 ± 6% and -22.4 ± 3 %, P < 0.001 and P < 0.05, respectively). Administration of 100 mg/kg/day MA significantly protected the heart from general atrophy (633.8 ± 30 mg vs. placebo 474 ± 13 mg, P < 0.001). Tumour-bearing rats displayed cardiac dysfunction, as indicated by the significant impairment of the left ventricular ejection fraction, the left ventricular fractional shortening, the stroke volume, the end dyastolic volume, and the end systolic volume. In contrast, MA significantly improved left ventricular ejection fraction, left ventricular fractional shortening, and left ventricular end systolic volume. Western blotting analysis showed an upregulation of the autophagic pathway in the gastrocnemius and hearts of the placebo-treated tumour-bearing rats. Treatment with MA, however, was able to modulate the autophagic markers (e.g. Beclin-1, p62, TRAF6, and LC3) in the gastrocnemius and in the hearts of tumour-bearing rats. Most importantly, 100 mg/kg/day MA reduced mortality [hazard ratio (HR): 0.44; 95%CI: 0.20-1.00; P = 0.0486]. CONCLUSIONS Megestrol acetate improved survival and reduced wasting through a marked downregulation of autophagy, occurring in both skeletal and heart muscle, the latter effect leading to a significant improvement of cardiac function. Our data suggest that MA might represent a valuable strategy to counteract the development of cancer cachexia-induced cardiomyopathy.
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Affiliation(s)
- Vincenzo Musolino
- Institute of Research for Food Safety and Health (IRC-FSH) University of Catanzaro 'Magna Graecia' Catanzaro Italy
| | - Sandra Palus
- Division of Innovative Clinical Trials, Department of Cardiology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Anika Tschirner
- Applied Cachexia Research, Department of Cardiology Charité Medical School Berlin Germany
| | - Cathleen Drescher
- Division of Innovative Clinical Trials, Department of Cardiology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Micaela Gliozzi
- Institute of Research for Food Safety and Health (IRC-FSH) University of Catanzaro 'Magna Graecia' Catanzaro Italy
| | - Cristina Carresi
- Institute of Research for Food Safety and Health (IRC-FSH) University of Catanzaro 'Magna Graecia' Catanzaro Italy
| | - Cristiana Vitale
- Centre for Clinical and Basic Research IRCCS San Raffaele Pisana Rome Italy
| | - Carolina Muscoli
- Institute of Research for Food Safety and Health (IRC-FSH) University of Catanzaro 'Magna Graecia' Catanzaro Italy; Centre for Clinical and Basic Research IRCCS San Raffaele Pisana Rome Italy
| | - Wolfram Doehner
- Center for Stroke Research Charité Medical School, Campus Virchow- Klinikum Berlin Germany
| | - Stephan von Haehling
- Division of Innovative Clinical Trials, Department of Cardiology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Vincenzo Mollace
- Institute of Research for Food Safety and Health (IRC-FSH) University of Catanzaro 'Magna Graecia' Catanzaro Italy; Centre for Clinical and Basic Research IRCCS San Raffaele Pisana Rome Italy
| | - Jochen Springer
- Division of Innovative Clinical Trials, Department of Cardiology University Medical Center Göttingen (UMG) Göttingen Germany
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Kim JM, Sung MK. The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review. Clin Nutr Res 2016; 5:219-236. [PMID: 27812512 PMCID: PMC5093220 DOI: 10.7762/cnr.2016.5.4.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 10/15/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022] Open
Abstract
Cancer is currently a leading cause of deaths worldwide and the number of new cases is growing rapidly in both, developed and developing countries. Nutritional management during and after cancer treatment affects treatment efficacy and patient quality of life (QOL). This review systemically examined the effect of oral nutritional interventions on nutritional and clinical outcomes in cancer patients. We especially focused on outcomes such as nutritional status indices, immune-associated biochemical markers, and QOL assessments to provide insights on the applicability of different outcomes. A total of 28 papers were selected for systematic review. The nutritional composition of oral nutritional supplements (ONS), outcome measures, and efficacy of the oral nutritional interventions were summarized and discussed. Most ONS contain 1 or more functional components in addition to basic nutrients. Each study used various outcome measures and significant efficacy was observed for a limited number of measures. Nutritional status indices, QOL measures, and the duration of hospital stay improved in about 40% of the studies. One or more markers of immune function and inflammatory responses were improved by ONS in 65% of the selected studies. These results suggest that appropriate use of ONS may be an ideal way to improve treatment efficacy; however, additional intervention trials are required to confirm these findings.
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Affiliation(s)
- Jin-Min Kim
- Department of Food and Nutrition, Sookmyung Women's University, Seoul 04310, Korea
| | - Mi-Kyung Sung
- Department of Food and Nutrition, Sookmyung Women's University, Seoul 04310, Korea
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Cai B, Chen H, Sun H, Wan P, Sun H, Pan J. Production of immunoregulatory polysaccharides from Crassostrea hongkongensis and their positive effects as a nutrition factor in modulating the effectiveness and toxicity of 5-FU chemotherapy in mice. Food Funct 2016; 7:390-7. [PMID: 26507007 DOI: 10.1039/c5fo00885a] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chemotherapy is generally accompanied by undesirable side effects, such as immunosuppression and malnutrition, which reduce tolerance to cancer therapies. Prior studies have shown that immunonutrition improves the clinical outcomes of cancer patients. In this study, immunoregulatory polysaccharides from Crassostrea hongkongensis were included in a nutrition formula that was administered to S180 tumor-bearing mice in combination with 5-fluorouracil (5-FU) treatment. The C30-60% fraction of the polysaccharides was characterized as a branched polysaccharide, with a high amount of d-glucose (96.76% of the total) and the highest uronic acid and sulfate groups' content among all of the polysaccharide fractions. The C30-60% polysaccharide fraction showed a maximal proliferative effect on RAW264.7 cells and T lymphocytes at a concentration of 0.0391 mg mL(-1) and 0.0781 mg mL(-1), respectively. Moreover, the combination treatment of the C30-60% polysaccharide-based nutrition formula (OPNF) with the administration of 5-FU effectively inhibited the growth of tumors and notably increased the leucocyte and lymphocyte counts in S180 tumor-bearing mice. In addition, a slight increase in the erythrocyte and hemoglobin values was observed in the mice treated with the combination of OPNF and 5-FU. These results suggest that supplementation with a C30-60%-based enteral formula would be beneficial for patients undergoing chemotherapy with 5-FU.
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Affiliation(s)
- Bingna Cai
- Key Laboratory of Tropical Marine Bio-resource and Ecology/Guangdong Key Laboratory of Marine Meteria Medica, South China Sea Institute of Oceanology, Chinese Academy of Sciences, 164-Xingangxi Road, Guangzhou, 510301, China.
| | - Hua Chen
- Key Laboratory of Tropical Marine Bio-resource and Ecology/Guangdong Key Laboratory of Marine Meteria Medica, South China Sea Institute of Oceanology, Chinese Academy of Sciences, 164-Xingangxi Road, Guangzhou, 510301, China.
| | - Han Sun
- Rutgers University, 98 Brett Road, Piscataway, New Jersey 08854, USA
| | - Peng Wan
- Key Laboratory of Tropical Marine Bio-resource and Ecology/Guangdong Key Laboratory of Marine Meteria Medica, South China Sea Institute of Oceanology, Chinese Academy of Sciences, 164-Xingangxi Road, Guangzhou, 510301, China.
| | - Huili Sun
- Key Laboratory of Tropical Marine Bio-resource and Ecology/Guangdong Key Laboratory of Marine Meteria Medica, South China Sea Institute of Oceanology, Chinese Academy of Sciences, 164-Xingangxi Road, Guangzhou, 510301, China.
| | - Jianyu Pan
- Key Laboratory of Tropical Marine Bio-resource and Ecology/Guangdong Key Laboratory of Marine Meteria Medica, South China Sea Institute of Oceanology, Chinese Academy of Sciences, 164-Xingangxi Road, Guangzhou, 510301, China.
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Abstract
BACKGROUND In general, cancer is a disease of aging, and palliative care is an essential step in the management of cancer in patients who are older. The goal of this article is to review common symptoms of cancer and oncology treatment and their management. METHODS The pertinent medical literature was reviewed. RESULTS The scope of palliative care includes personalized cancer treatment. This involves choosing treatment options that best fit the needs of each individual patient. Balancing treatment benefits and risks may be challenging in older patients, many of whom have limited life expectancies and decreased functional reserves. The benefits of treatment may diminish, and the risks of such treatment options increase with age. Thus, the first step toward personalized treatment includes determining physiological age, which is best estimated with a comprehensive geriatric assessment. Prevention of common complications, which include neutropenia and mucositis, allows the administration of treatment in full and effective doses. Fatigue is a chronic symptom related to cancer and its treatment and may lead to functional dependence and an increased risk of death. Fatigue might be prevented by daily exercise even during treatment. Other symptoms include pain and feelings of memory loss. CONCLUSIONS The scope of palliative care encompasses more issues that symptom management and, for this reason, palliative care should be provided once the diagnosis of cancer is established. Determining treatment goals is essential to improve the treatment experience. Symptom management is similar in older and young patients, but symptoms in the older population may be associated with more frequent and severe complications. Many options exist to prevent and ameliorate the complications of oncology treatment in the aged. However, more studies should be conducted on the long-term care of older patients who have survived cancer.
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Gamallat Y, Meyiah A, Kuugbee ED, Hago AM, Chiwala G, Awadasseid A, Bamba D, Zhang X, Shang X, Luo F, Xin Y. Lactobacillus rhamnosus induced epithelial cell apoptosis, ameliorates inflammation and prevents colon cancer development in an animal model. Biomed Pharmacother 2016; 83:536-541. [PMID: 27447122 DOI: 10.1016/j.biopha.2016.07.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/14/2016] [Accepted: 07/01/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIM Probiotics have been suggested as prophylactic measure in colon carcinogenesis. This study aimed at determining the potential prophylactic activity of Lactobacillus rhamnosus GG CGMCC 1.2134 (LGG) strain on colorectal carcinogenesis via measuring its effect on Nuclear factor kappa B (NFκB) inflammatory pathway and apoptosis. MATERIALS AND METHODS 64 Sprague Dawley rats were grouped into four as follows; Group 1 (Healthy control), Group 2 (LGG), Group 3 (cancer control Dimethyl hydrazine (DMH)) and Group 4 (LGG+DMH). LGG was administered orally to LGG and LGG+DMH groups. Colon carcinogenesis was chemically induced in LGG+DMH and DMH groups by weekly injection of 40mg/kg DMH. Animals were sacrificed after 25 weeks of experiment and tumor characteristics assessed. The change in expression of NFκB-p65, COX-2, TNFα, Bcl-2, Bax, iNOS, VEGFα, β-catenin, Casp3 and p53 were evaluated by western blotting and qRT-PCR. RESULTS LGG treatment significantly reduced tumor incidence, multiplicity and volume in LGG+DMH treatment group compared to DMH cancer control group. Also, LGG treatment reduced the expression of β-catenin and the inflammatory proteins NFκB-p65, COX-2 and TNFα; the anti-apoptotic protein Bcl-2, but increased the expression of the pro-apoptotic proteins Bax, casp3 and p53 compared with DMH group. CONCLUSION LGG have a potential protection effect against colon carcinogenesis; inducing apoptosis and ameliorating inflammation, and may hold a promise as bio-therapeutic dietary agent.
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Affiliation(s)
- Yaser Gamallat
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Abdo Meyiah
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Eugene D Kuugbee
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Ahmed Musa Hago
- Department of Pathology and Pathophysiology, Dalian Medical University, Dalian 116044, China
| | - Gift Chiwala
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Annoor Awadasseid
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Djibril Bamba
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Xin Zhang
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Xueqi Shang
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China
| | - Fuwen Luo
- Department of Acute abdominal Surgery, Second Affiliated Hospital of Dalian Medical University, China.
| | - Yi Xin
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China.
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Cancer Appetite and Symptom Questionnaire (CASQ) for Brazilian Patients: Cross-Cultural Adaptation and Validation Study. PLoS One 2016; 11:e0156288. [PMID: 27275947 PMCID: PMC4898714 DOI: 10.1371/journal.pone.0156288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Appetite and symptoms, conditions generally reported by the patients with cancer, are somewhat challenging for professionals to measure directly in clinical routine (latent conditions). Therefore, specific instruments are required for this purpose. This study aimed to perform a cultural adaptation of the Cancer Appetite and Symptom Questionnaire (CASQ), into Portuguese and evaluate its psychometric properties on a sample of Brazilian cancer patients. METHODS This is a validation study with Brazilian cancer patients. The face, content, and construct (factorial and convergent) validities of the Cancer Appetite and Symptom Questionnaire, the study tool, were estimated. Further, a confirmatory factor analysis (CFA) was conducted. The ratio of chi-square and degrees of freedom (χ2/df), comparative fit index (CFI), goodness of fit index (GFI) and root mean square error of approximation (RMSEA) were used for fit model assessment. In addition, the reliability of the instrument was estimated using the composite reliability (CR) and Cronbach's alpha coefficient (α), and the invariance of the model in independent samples was estimated by a multigroup analysis (Δχ2). RESULTS Participants included 1,140 cancer patients with a mean age of 53.95 (SD = 13.25) years; 61.3% were women. After the CFA of the original CASQ structure, 2 items with inadequate factor weights were removed. Four correlations between errors were included to provide adequate fit to the sample (χ2/df = 8.532, CFI = .94, GFI = .95, and RMSEA = .08). The model exhibited a low convergent validity (AVE = .32). The reliability was adequate (CR = .82 α = .82). The refined model showed strong invariance in two independent samples (Δχ2: λ: p = .855; i: p = .824; Res: p = .390). A weak stability was obtained between patients undergoing chemotherapy and radiotherapy (Δχ2: λ: p = .155; i: p < .001; Res: p < .001), and between patients undergoing chemotherapy combined with radiotherapy and palliative care (Δχ2: λ: p = .058; i: p < .001; Res: p < .001). CONCLUSION The Portuguese version of the CASQ had good face and construct validity and reliability. However, the CASQ still presented invariance in independent samples of Brazilian patients with cancer. However, the tool has low convergent validity and weak invariance in samples with different treatments.
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Xinhua W, Xiangting Q, Lingling C, Guohong L. Prognostic Significance of Serum CD26 Concentration in Patients with Esophageal Squamous Cell Carcinoma. Arch Med Res 2016; 47:299-303. [DOI: 10.1016/j.arcmed.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
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Sukumaran S, Patel HJ, Patel BM. Evaluation of role of telmisartan in combination with 5-fluorouracil in gastric cancer cachexia. Life Sci 2016; 154:15-23. [PMID: 27117583 DOI: 10.1016/j.lfs.2016.04.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/14/2016] [Accepted: 04/22/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of the present study was to evaluate the effect of combination of telmisartan with 5-flourouracil (5-FU) in gastric cancer cachexia induced by administering N-methyl-N'-methyl-N-nitrosoguanidine (MNNG). METHOD MNND was administered once daily by oral gavage for two weeks, and saturated NaCl (1ml per rat) was then given once every 3days for 4weeks. 5-FU (75mg/kg, i.v.) was administered once three weeks from 7th to 22nd week. From 7th to 22nd week, telmisartan (5mg/kg, p.o.) was also administered along with 5-FU. RESULT MNNG produced significant decrease in food intake, body weight, caused hyperglycemia, dyslipidemia, hypertension worsened hemodyanamics, increased cachexia markers and increased tumor markers like lactate dehydrogenase and γ-glutamyltransferase. MNNG also produced oxidative stress in the stomach tissue. Treatment with combination of telmisartan with 5-FU produced significant increase in food intake and body weight, controlled hyperglycemia and dyslipidemia, preserved hemodynamic function, and decreased the cachexia markers while 5-FU alone did not produce any such effects. Further, the combination of telmisartan with 5-FU significantly reduced tumor marker levels, oxidative stress and also significantly decreased the cell proliferation, apoptosis, hyperkeratosis, keratohyaline granules and invasive carcinoma of forestomach and reduced muscle atrophy in tibilias anterior skeletal muscle. CONCLUSION Our data suggests that combination of telmisartan with 5-FU treatment is beneficial in controlling cancer cachexia. Telmisartan can be used as an add-on therapy with 5-FU or other traditional chemotherapeutic agents.
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Cui W, Bennett AW, Zhang P, Barrow KR, Kearney SR, Hankey KG, Taylor-Howell C, Gibbs AM, Smith CP, MacVittie TJ. A non-human primate model of radiation-induced cachexia. Sci Rep 2016; 6:23612. [PMID: 27029502 PMCID: PMC4814846 DOI: 10.1038/srep23612] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/10/2016] [Indexed: 12/25/2022] Open
Abstract
Cachexia, or muscle wasting, is a serious health threat to victims of radiological accidents or patients receiving radiotherapy. Here, we propose a non-human primate (NHP) radiation-induced cachexia model based on clinical and molecular pathology findings. NHP exposed to potentially lethal partial-body irradiation developed symptoms of cachexia such as body weight loss in a time- and dose-dependent manner. Severe body weight loss as high as 20–25% was observed which was refractory to nutritional intervention. Radiographic imaging indicated that cachectic NHP lost as much as 50% of skeletal muscle. Histological analysis of muscle tissues showed abnormalities such as presence of central nuclei, inflammation, fatty replacement of skeletal muscle, and muscle fiber degeneration. Biochemical parameters such as hemoglobin and albumin levels decreased after radiation exposure. Levels of FBXO32 (Atrogin-1), ActRIIB and myostatin were significantly changed in the irradiated cachectic NHP compared to the non-irradiated NHP. Our data suggest NHP that have been exposed to high dose radiation manifest cachexia-like symptoms in a time- and dose-dependent manner. This model provides a unique opportunity to study the mechanism of radiation-induced cachexia and will aid in efficacy studies of mitigators of this disease.
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Affiliation(s)
- Wanchang Cui
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Alexander W Bennett
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Pei Zhang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Kory R Barrow
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Sean R Kearney
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Kim G Hankey
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Cheryl Taylor-Howell
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Allison M Gibbs
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Cassandra P Smith
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
| | - Thomas J MacVittie
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA 10 South Pine Street, MSTF Room 604, Baltimore, MD 21201 USA
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83
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Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 2016; 75:199-211. [PMID: 26786393 DOI: 10.1017/s002966511500419x] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.
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84
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Nakamura S, Narimatsu H, (Ito) Sasahara Y, Sho R, Kawasaki R, Yamashita H, Kubota I, Ueno Y, Kato T, Yoshioka T, Fukao A, Kayama T. Health management in cancer survivors: Findings from a population-based prospective cohort study-the Yamagata Study (Takahata). Cancer Sci 2015; 106:1607-15. [PMID: 26471007 PMCID: PMC4714694 DOI: 10.1111/cas.12811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 12/14/2022] Open
Abstract
The number of cancer survivors is increasing; however, optimal health management of cancer survivors remains unclear due to limited knowledge. To elucidate the risk of non-communicable diseases, and the effect of lifestyle habits on risk of non-communicable diseases, we compared cancer survivors and those who never had cancer (non-cancer controls) using a population-based prospective cohort study. The baseline survey of 2292 participants was carried out from 2004 to 2006, and the follow-up survey of 2124 participants was carried out in 2011. We compared the baseline characteristics and the risk of non-communicable diseases between cancer survivors and non-cancer controls. Analyzed participants included 124 cancer survivors (men/women, 57/67), and 2168 non-cancer controls (939/1229). Several lifestyle factors and nutritional intake significantly differed between survivors and non-cancer controls, although smoking status did not differ between the groups (P = 0.30). Univariate logistic regression analysis showed increased risk of death (odds ratio [OR], 3.64; 95% confidence interval [CI], 2.19-6.05) and heart disease (OR, 2.60; 95% CI, 1.06-6.39) in cancer survivors. Increased risk of heart disease was also significant (OR, 2.95; 95% CI, 1.05-8.26; P = 0.04) in the multivariate analysis of the smoking-related cancer subgroup. Current smoking significantly increased risk of death (OR, 2.42; 95% CI, 1.13-5.18). Specific management should be implemented for cancer survivors. More intense management against smoking is necessary, as continued smoking in cancer survivors may increase the risk of second primary cancer. Moreover, cancer survivors are at a high risk of heart disease; thus, additional care should be taken.
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Affiliation(s)
- Sho Nakamura
- Department of Clinical OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Hiroto Narimatsu
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
- Cancer Prevention and Control DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
| | - Yuriko (Ito) Sasahara
- Department of Clinical OncologyFaculty of MedicineYamagata UniversityYamagataJapan
- Department of Medical OncologyYamagata Prefectural Central HospitalYamagataJapan
| | - Ri Sho
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
| | - Ryo Kawasaki
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual SciencesFaculty of MedicineYamagata UniversityYamagataJapan
| | - Isao Kubota
- Department of First Department of Internal MedicineFaculty of MedicineYamagata UniversityYamagataJapan
| | - Yoshiyuki Ueno
- Department of Second Department of Internal MedicineFaculty of MedicineYamagata UniversityYamagataJapan
| | - Takeo Kato
- Department of Third Department of Internal MedicineFaculty of MedicineYamagata UniversityYamagataJapan
| | - Takashi Yoshioka
- Department of Clinical OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Akira Fukao
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
| | - Takamasa Kayama
- Department of Advanced Cancer ScienceFaculty of MedicineYamagata UniversityYamagataJapan
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85
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Mechanisms of anorexia-cachexia syndrome and rational for treatment with selective ghrelin receptor agonist. Cancer Treat Rev 2015; 41:793-7. [PMID: 26386985 DOI: 10.1016/j.ctrv.2015.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/14/2022]
Abstract
Cancer cachexia is a multi-organ, multifactorial and often irreversible syndrome affecting many patients with cancer. Cancer cachexia is invariably associated with weight loss, mainly from loss of skeletal muscle and body fat, conditioning a reduced quality of life due to asthenia, anorexia, anaemia and fatigue. Treatment options for treating cancer cachexia are limited. The approach is multimodal and may include: treatment of secondary gastrointestinal symptoms, nutritional treatments, drug, and non-drug treatments. Nutritional counselling and physical training may be beneficial in delaying or preventing the development of anorexia-cachexia. However, these interventions are limited in their effect, and no definitive pharmacological treatment is available to address the relevant components of the syndrome. Anamorelin is a first-in-class, orally active ghrelin receptor agonist that binds and stimulates the growth hormone secretagogue receptor centrally, thereby mimicking the appetite-enhancing and anabolic effects of ghrelin. It represents a new class of drug and an additional treatment option for this patient group, whose therapeutic options are currently limited. In this review we examine the mechanisms of anamorelin by which it contrasts catabolic states, its role in regulation of metabolism and energy homeostasis, the data of recent trials in the setting of cancer cachexia and its safety profile.
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86
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Huang YT, Cheng CC, Chiu TH, Lai PC. Therapeutic potential of thalidomide for gemcitabine-resistant bladder cancer. Int J Oncol 2015; 47:1711-24. [PMID: 26398114 DOI: 10.3892/ijo.2015.3155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/23/2015] [Indexed: 11/05/2022] Open
Abstract
Controversial effects of thalidomide for solid malignancies have been reported. In the present study, we evaluate the effects of thalidomide for transitional cell carcinoma (TCC), the most common type of bladder cancer. Thalidomide precipitates were observed when its DMSO solution was added to the culture medium. No precipitation was found when thalidomide was dissolved in 45% γ-cyclodextrin, and this concentration of γ-cyclodextrin elicited slight cytotoxicity on TCC BFTC905 and primary human urothelial cells. Thalidomide-γ-cyclodextrin complex exerted a concentration-dependent cytotoxicity in TCC cells, but was relatively less cytotoxic (with IC50 of 200 µM) in BFTC905 cells than the other 3 TCC cell lines, possibly due to upregulation of Bcl-xL and HIF-1α mediated carbonic anhydrase IX, and promotion of quiescence. Gemcitabine-resistant BFTC905 cells were chosen for additional experiments. Thalidomide induced apoptosis through downregulation of survivin and securin. The secretion of VEGF and TNF-α was ameliorated by thalidomide, but they did not affect cell proliferation. Immune-modulating lenalidomide and pomalidomide did not elicit cytotoxicity. In addition, cereblon did not play a role in the thalidomide effect. Oxidative DNA damage was triggered by thalidomide, and anti-oxidants reversed the effect. Thalidomide also inhibited TNF-α induced invasion through inhibition of NF-κB, and downregulation of effectors, ICAM-1 and MMP-9. Thalidomide inhibited the growth of BFTC905 xenograft tumors in SCID mice via induction of DNA damage and suppression of angiogenesis. Higher average body weight, indicating less chachexia, was observed in thalidomide treated group. Sedative effect was observed within one-week of treatment. These pre-clinical results suggest therapeutic potential of thalidomide for gemcitabine-resistant bladder cancer.
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Affiliation(s)
- Yen Ta Huang
- Department of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Chuan Chu Cheng
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, R.O.C
| | - Ted H Chiu
- Department of Pharmacology, College of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Pei Chun Lai
- Department of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
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87
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Dunn IC, Wilson PW, D'Eath RB, Boswell T. Hypothalamic Agouti-Related Peptide mRNA is Elevated During Natural and Stress-Induced Anorexia. J Neuroendocrinol 2015; 27:681-91. [PMID: 26017156 PMCID: PMC4973702 DOI: 10.1111/jne.12295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 01/14/2023]
Abstract
As part of their natural lives, animals can undergo periods of voluntarily reduced food intake and body weight (i.e. animal anorexias) that are beneficial for survival or breeding, such as during territorial behaviour, hibernation, migration and incubation of eggs. For incubation, a change in the defended level of body weight or 'sliding set point' appears to be involved, although the neural mechanisms reponsible for this are unknown. We investigated how neuropeptide gene expression in the arcuate nucleus of the domestic chicken responded to a 60-70% voluntary reduction in food intake measured both after incubation and after an environmental stressor involving transfer to unfamiliar housing. We hypothesised that gene expression would not change in these circumstances because the reduced food intake and body weight represented a defended level in birds with free access to food. Unexpectedly, we observed increased gene expression of the orexigenic peptide agouti-related peptide (AgRP) in both incubating and transferred animals compared to controls. Also pro-opiomelanocortin (POMC) mRNA was higher in incubating hens and significantly increased 6 days after exposure to the stressor. Conversely expression of neuropeptide Y and cocaine- and amphetamine-regulated transcript gene was unchanged in both experimental situations. We conclude that AgRP expression remains sensitive to the level of energy stores during natural anorexias, which is of adaptive advantage, although its normal orexigenic effects are over-ridden by inhibitory signals. In the case of stress-induced anorexia, increased POMC may contribute to this inhibitory role, whereas, for incubation, reduced feeding may also be associated with increased expression in the hypothalamus of the anorexigenic peptide vasoactive intestinal peptide.
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Affiliation(s)
- I C Dunn
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - P W Wilson
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - R B D'Eath
- Animal Behaviour & Welfare, Veterinary Science Research Group, SRUC, West Mains Road, Edinburgh, EH9 3JG, UK
| | - T Boswell
- School of Biology, Centre for Behaviour and Evolution, Newcastle University, Newcastle-Upon-Tyne, UK
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88
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Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Support Care Cancer 2015; 24:429-435. [DOI: 10.1007/s00520-015-2813-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
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89
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Pouwer F. Impact of cancer on use of glucose-lowering drug treatment in individuals with diabetes: potential mechanisms. Diabetologia 2015; 58:1378-9. [PMID: 25773406 DOI: 10.1007/s00125-015-3560-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Frans Pouwer
- Department of Medical and Clinical Psychology, CoRPS, Tilburg University, Postbus 90153, 5000 LE, Tilburg, the Netherlands,
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90
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Gorenc M, Kozjek NR, Strojan P. Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy. Rep Pract Oncol Radiother 2015; 20:249-58. [PMID: 26109912 DOI: 10.1016/j.rpor.2015.03.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/26/2014] [Accepted: 03/02/2015] [Indexed: 12/18/2022] Open
Abstract
AIM To highlight the problems associated with nutrition that occur in patients with squamous cell carcinoma of the head and neck (SCCHN). BACKGROUND SCCHN is associated with weight loss before, during and after radiotherapy or concurrent chemoradiotherapy. Because of serious consequences of malnutrition and cachexia on treatment outcome, mortality, morbidity, and quality of life, it is important to identify SCCHN patients with increased risk for the development of malnutrition and cachexia. MATERIALS AND METHODS Critical review of the literature. RESULTS This review describes pathogenesis, diagnosis and treatment of malnutrition and cancer cachexia. Treatment of malnutrition and cancer cachexia includes nutritional interventions and pharmacological therapy. Advantages and disadvantages of different nutritional interventions and their effect on the nutritional status, quality of life and specific oncological treatment are presented. CONCLUSIONS Nutritional management is an essential part of care of these patients, including early screening, assessment of nutritional status and appropriate intervention.
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Affiliation(s)
- Mojca Gorenc
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000 Ljubljana, Slovenia
| | - Nada Rotovnik Kozjek
- Clinical Nutrition Unit, Institute of Oncology Ljubljana, Zaloška 2, SI-1000 Ljubljana, Slovenia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000 Ljubljana, Slovenia
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91
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Yuan L, Han J, Meng Q, Xi Q, Zhuang Q, Jiang Y, Han Y, Zhang B, Fang J, Wu G. Muscle-specific E3 ubiquitin ligases are involved in muscle atrophy of cancer cachexia: an in vitro and in vivo study. Oncol Rep 2015; 33:2261-8. [PMID: 25760630 DOI: 10.3892/or.2015.3845] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/09/2015] [Indexed: 11/06/2022] Open
Abstract
Muscle atrophy F-Box (MAFbx)/atrogin-1 and muscle ring-finger-1 (MuRF-1) have been identified as two muscle-specific E3 ubiquitin ligases that are highly expressed in skeletal muscle during muscle atrophy. However, the role of muscle-specific E3 ubiquitin ligases during the process of muscle atrophy of cancer cachexia remains largely unknown. In the present study, we analyzed the expression of atrogin-1 and MuRF-1 in the skeletal muscle of patients with malignant and benign disease. The possible mechanisms were studied both in a colon 26-induced cancer cachexia mouse model and in tumor necrosis factor-α (TNF-α) induced atrophy C2C12 cells. Our results demonstrated that atrogin-1 and MuRF-1 tended to be increased in the skeletal muscle of patients with malignant disease even before weight loss. Non-tumor body weights and gastrocnemius weights were significantly decreased while expression levels of ubiquitin proteasome pathway associated genes (atrogin-1, MuRF-1, ubiquitin and E2-14K) were upregulated in cancer cachexia mice. Significant myotube atrophy with atrogin-1 overexpression was observed in the C2C12 cells treated with TNF-α. Meanwhile, knockdown of atrogin-1 by small interfering RNA (siRNA) protected C2C12 cells from the adverse effect of TNF-α. In conclusion, muscle-specific E3 ubiquitin ligases were upregulated during cancer cachexia, and atrogin-1 may be a potential molecular target for treating muscle atrophy induced by cancer cachexia.
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Affiliation(s)
- Lei Yuan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Jun Han
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qingyang Meng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qiulei Xi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qiulin Zhuang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Yi Jiang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Yusong Han
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Bo Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Jing Fang
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, P.R. China
| | - Guohao Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
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93
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Abstract
PURPOSE OF REVIEW To review new putative mechanisms involved in the pathophysiology of a disturbed energy balance in cancer cachexia, which can lead to novel targets for clinical cachexia management. In the context of rapid developments in tumour treatment with potential systemic consequences, this article reviews recent data on energy requirements. Furthermore, we focus on new insights in brown adipose tissue (BAT) activity and reward processing in the brain in relation to the cachexia process. RECENT FINDINGS Nearly no new data have been published on energy requirements of cancer patients in the light of comprehensive new therapies in oncology. New developments, such as the introduction of staging with 18F-fluorodeoxyglucose PET-computed tomography scanning, led to the observation that BAT activation may contribute to impaired energy balance in cancer cachexia. Animal and human data to date provide an indication that BAT activation indeed occurs, but its quantitative impact on the degree of cachexia is controversial. The peripheral and central nervous system is known to influence satiation, with a possible role for impaired food reward processing in the brain. To date, there are limited confirmatory data, but this is an interesting new area to explore for better understanding and treating cancer-induced anorexia. SUMMARY The multimodal approach to counteract cancer cachexia should expand its targets to BAT and food reward processing in the brain.
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Affiliation(s)
- Judith de Vos-Geelen
- aDepartment of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands bDepartment of Surgery, University of Edinburgh, Edinburgh, United Kingdom cDepartment of Respiratory Medicine, NUTRIM School of Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
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94
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Plotnikoff GA. Introduction: What to Eat when you Can't Eat. Glob Adv Health Med 2014; 3:56-72. [PMID: 25568833 PMCID: PMC4268644 DOI: 10.7453/gahmj.2014.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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95
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Serum levels of resistin, adiponectin, and apelin in gastroesophageal cancer patients. DISEASE MARKERS 2014; 2014:619649. [PMID: 25049439 PMCID: PMC4094727 DOI: 10.1155/2014/619649] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/30/2014] [Indexed: 12/23/2022]
Abstract
The aim of the study was the investigation of relationship between cachexia syndrome and serum resistin, adiponectin, and apelin in patients with gastroesophageal cancer (GEC). Material and Methods. Adipocytokines concentrations were measured in sera of 85 GEC patients and 60 healthy controls. They were also evaluated in tumor tissue and appropriate normal mucosa of 38 operated cancer patients. Results. Resistin and apelin concentrations were significantly higher in GEC patients than in the controls. The highest resistin levels were found in cachectic patients and in patients with distant metastasis. Serum adiponectin significantly decreased in GEC patients with regional and distant metastasis. Serum apelin was significantly higher in cachectic patients than in the controls. Apelin was positively correlated with hsCRP level. Resistin and apelin levels increased significantly in tumor tissues. Weak positive correlations between adipocytokines levels in serum and in tumor tissue were observed. Conclusions. Resistin is associated with cachexia and metastasis processes of GEC. Reduction of serum adiponectin reflects adipose tissue wasting in relation to GEC progression. Correlation of apelin with hsCRP can reflect a presumable role of apelin in systemic inflammatory response in esophageal and gastric cancer.
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96
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Abstract
INTRODUCTION To assess the efficacy of herbal medicines as a treatment of cancer cachexia. METHODS AND ANALYSIS We will search the following 13 electronic databases from their inception. MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Allied and Complementary Medicine Database (AMED), China National Knowledge Infrastructure (CNKI), Wanfang, Journal Integration Platform (VIP) and six Korean Medical Databases (KoreaMed, the Korean Traditional knowledge Portal, OASIS, DBPIA, the Research Information Service System and the Korean Studies Information Service System) without restrictions on time or language. The data will be extracted independently by two authors using predefined criteria. Disagreements will be resolved by discussion between the authors. The risk of bias will be assessed using the Cochrane risk of bias tool. DISSEMINATION The review will be published in a journal. The review will also be disseminated electronically and in print. An update of the review will be conducted to inform and guide healthcare practice and policy. TRIAL REGISTRATION NUMBER PROSPERO 2013:CRD42013006612.
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Affiliation(s)
- Bongki Park
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ji Hee Jun
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jeeyoun Jung
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Sooseong You
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Myeong Soo Lee
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
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97
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Ma JD, Heavey SF, Revta C, Roeland EJ. Novel investigational biologics for the treatment of cancer cachexia. Expert Opin Biol Ther 2014; 14:1113-20. [PMID: 24707881 DOI: 10.1517/14712598.2014.907788] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Cancer cachexia is a complex multifactorial syndrome characterized by ongoing, irreversible skeletal muscle loss, leading to progressive functional impairment. Several investigational biologics targeting key inflammatory pathways and/or the myostatin/activin type II receptor pathway are in development. AREAS COVERED Novel therapies include ALD518, MABp1, IP-1510, OHR/AVR118, bimagrumab and REGN1033 and are discussed. For each investigational therapy, the mechanism of action, preclinical data, cachexia definition, indication and clinical data are discussed. EXPERT OPINION A critical look of the study protocols and two key challenges limiting the successful evaluation of these agents include: i) lack of a clinically meaningful cachexia definition; and ii) identification and treatment of cachexia in late stage. We describe our observations and clinical experience in an effort to redirect and promote successful strategies to evaluate these novel investigational biologics.
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Affiliation(s)
- Joseph D Ma
- University of California (UC), San Diego, Skaggs School of Pharmacy & Pharmaceutical Sciences , 9500 Gilman Drive, MC 0714, La Jolla, CA 92093-0714 , USA
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98
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Di Girolamo FG, Situlin R, Mazzucco S, Valentini R, Toigo G, Biolo G. Omega-3 fatty acids and protein metabolism: enhancement of anabolic interventions for sarcopenia. Curr Opin Clin Nutr Metab Care 2014; 17:145-50. [PMID: 24500439 DOI: 10.1097/mco.0000000000000032] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The increased age observed in most countries, with the associated higher rates of chronic illnesses and cancer, and a diffuse sedentary lifestyle, will increase the number of patients with clinically relevant anabolic resistance, sarcopenia and its complications. The need for solutions to this major health issue is, therefore, pressing. RECENT FINDINGS The metabolic derangements and other consequences associated with sarcopenia can be slowed or even prevented by specific nutritional interventions. New evidence is available about the efficacy of omega-3 fatty acid dietary supplementation to improve protein metabolism and counteract anabolic resistance through indirect effects. Studies show that the anabolic stimuli from substrates (e.g. amino acids or proteins), hormones (e.g. insulin) and/or physical activity in skeletal muscle can be enhanced by long-term fish oil administration. SUMMARY The review of data from recent studies on this topic suggests that dietary omega-3 fatty acid supplementation, in association with an anabolic stimulus, could potentially provide a safe, simple and low-cost intervention to counteract anabolic resistance and sarcopenia. This intervention may contribute to prevent cachexia and disabilities. Supplementation should be given in the earlier stages of sarcopenia (e.g. precachexia). Further research should, however, be performed to better understand the mechanisms involved and the best dosage and timing of administration.
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Affiliation(s)
- Filippo Giorgio Di Girolamo
- aClinica Medica AOUTS, Department of Medical Sciences, University of Trieste bOrthopedic Unit AOUTS cGeriatric Unit AOUTS, Trieste, Italy
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